| NPI | 1376707281 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA LYNNETTE LEWELLEN Claims Specialist 817-517-9369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX L4308) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2008-07-17 |